ABSTRACT
Introduction: To provide breast cancer care during the COVID-19 pandemic, many centers shifted toward offering telehealth visits. We sought to determine the availability of telehealth services at Commission on Cancer (CoC)-accredited centers in the United States and factors associated with this virtual accessibility. Methods: Using a secret shopper model from June-September 2020, we contacted 371 CoC-accredited centers providing breast cancer care to determine whether they offered telehealth appointments. We analyzed factors associated with telehealth availability using bivariate and multivariate logistic regression analyses. Results: There were 316 of 371 (85.2%) hospitals that reported having telehealth capacity for breast cancer patients. Facility type (p=0.027), teaching hospital status (p=0.0001), geographic location (p=0.014), and hospital size (based on bed number, p=0.036) were all associated with telemedicine use on bivariate analysis (see table). For-profit vs not-for-profit status and the population base in which a center was located did not affect telehealth availability. On multivariate analysis, controlling for facility type, teaching hospital status and hospital size, only geographic location (p=0.004) was found to be an independent predictor of telehealth access, with centers located in the West being more than 6 times more likely to offer this provision than other regions, including the Northeast (OR:6.38;95% CI:1.27-32.00, p=0.024). Conclusion: While several hospital characteristics, including CoC designation, size, and teaching hospital status affected availability of telehealth visits, significant geographic disparities remained in telehealth provision independent of these factors. As COVID-19 forces medicine to increase its telehealth focus, particular attention should be paid to the geographic variation that may exacerbate access disparities. [Formula presented]
ABSTRACT
Background: The COVID-19 pandemic has dramatically accelerated the availability of telehealth services for patients with cancer. However, little national cross-sectional data is available to inform potential gaps in access. We aimed to characterize overall access to and trends in telehealth availability for new cancer care patients at hospitals across the United States. Methods: We performed a cross sectional secret-shopper study to evaluate the availability of telehealth services for new patients for three major cancer types- colorectal, breast, and skin cancer-at Commission on Cancer accredited hospitals during the period of April to November 2020. American Hospital Association and Center for Medicare and Medicaid Service databases were queried to determine hospital characteristics. We described hospital variation in access to telehealth services using descriptive statistics. Univariable and multivariable logistic regression were used to identify factors associated with telehealth availability. Results: Of 334 successfully contacted facilities, 248 (74%) offered new patient telehealth services for at least one cancer type. However, access differed by cancer site: telehealth availability for new patients with skin, colorectal, and breast cancer was 47%, 42%, and 38%, respectively. Of the facilities sampled, 47% offered telehealth for one cancer type, 40% for two cancer types, and 14% for all three cancer types. Rates of any telehealth access among the cancer types ranged from 61% at Community Cancer Programs to 100% at NCI Designated Programs. In multivariable logistic regression, facility type was significantly associated with telehealth access while factors such as bed size, ownership, and volume were not significantly associated. Conclusions: Although access to telehealth services for patients with cancer has increased, overall gaps in access remain. Within facility differences in telehealth access imply opportunities to better align services within institutions, though further investigation is warranted as these offerings mature. (Table Presented).